Fill and Sign the Child Custody Visitation Form

–– –– –– –– ––––– DV-110 DV-130 Protected person's name: ––––– Other parent's name: ––––– Mom Dad Other Mom Dad Other Child Custody is ordered as follows: a. ––––– b . ––––– C. ––––– ––––– ––––– ––––– if more children, check here. Attach a sheet ofpaper and write “DV-140, Item 3 * If Other, specify relationship to child and name ofperson: ––––– Child Visitation is ordered as follows: No visitation to See the attached The parties must go to mediation at- Until the next court order, visitation for Mom Dad Other (name): ––––– ––––– - page document, dated: ––––– ––––– Mom Dad Other ––––– Weekends (starting): 1st ––––– 2nd 3rd 4th 5th weekend of month from ––––– a. m. p.m. to ––––– a.m. p.m. Weekdays (starting): ––––– from ––––– a.m. p.m. to ––––– a.m. p.m. Other Visitation Supervised Visitation Responsibility for Transportation for Visitation Mom Mom Drop-off / pick-up of children will be at (address): Dad Dad Other (name): Other (name): ––––– ––––– –––––DV-140 Child Custody and Visitation Order Case Number: This form is attached to (check one): The Court Orders: Legal Custody to: (Person who makes decisions about health, Physical Custody to: (Person the child lives with. education, etc. Check at least one.) Check at least one.) Child's Name Date of Birth Mom Dad Other* Mom Dad Other* — Child Custody" at the top. a . b . c .d . will be: ( 1 ) (The 1st weekend of the month is the 1st weekend with a Saturday.) a t a t(day of we ek) (tim e) (day of week) (tim e) ( 2 ) a t a t(day of week) (tim e) (day of week) (tim e) ( 3 ) Check here and attach a sheet of paper if there are other visitation days and times, like holidays, birthdays, sports events. List dates and times. Write ''DV-140, Item 4 - Visitation" at the top. — Follow orders on attached Form DV- 150. ''Responsibility for transportation'' means the parent will take or pick up the child or make arrangements for someone else to do so. a . to the visits. b . from the visits. C . This is a Court Order. Child Custody and Visitation Order (Domestic Violence Prevention) DV- 140, Page I of 2 Form Adopted for Mandatory Use Judicial Council of California DV-140 [Rev. July 1, 2003] el ectr onic form ã 2003 WWW.LawCA.co m L a w P u b l i s h e r s654321 Protected person's name: ––––– ––––– Travel With Children Mom Dad Other (name): ––––– The State of California Other place(s) (list): ––––– Child Abduction Other Orders the United States of America other (specify): ––––– Case Number: must have written permission from the other parent, or a court order, to take the children outside of- a . b . There is a risk that one of the parents will take the children out of California without the other parent's permission. The orders in Form DV-145 are attached and must be obeyed. (Fill out and attach DV-145 to this form.) Check here and attach any other orders to this form. Write ''DV-140, Item 9 — Other Orders'' on the orders. Jurisdiction This court has jurisdiction to make child custody orders in this case under the Uniform Child Custody Jurisdiction and Enforcement Act (part 3 of the California Family Code starting with section 3400). Notice and Opportunity to Be Heard The responding party was given notice and an opportunity to be heard as provided by the laws of the State of California. Country of Habitual Residence The country of habitual residence of the child or children in this case iso r Penalties for Violating This Order If you violate this order, you may be subject to civil or criminal penalties, or both. This is a Court Order. Rev July 1, 2003 Child Custody and Visitation Order (Domestic Violence Prevention) DV- 140, Page 2 of 2el ectr onic form ã 2003 WWW.LawCA.co m L a w P u b l i s h e r s1 21 11 0987